But the irrigation certainly played a role in getting that percentage
so far below the national average. Normal saline is the most common
fluid used in wound irrigation. It doesn't have many side effects, nor
does it alter the normal healing of the wound. Besides being effective,
irrigation is also economical. A 250-ml bottle of saline costs around
$4. Granted, with all the surgeries you perform, those 4 dollars can
certainly add up fast. Of course, the cost of taking this precautionary
O C T O B E R 2 0 1 8 • O U T PA T I E N T S U R G E R Y. N E T • 7 7
LAP v. OPEN Cases:
Enhanced Recovery After Surgery Irrigation Protocol
APPROACH
1 LITERS IA
Irrigation
240 mg gent.
and 600 mg
clinda.
2 LITERS IA
Irrigation
240 mg gent.
and 600 mg
clinda.
4 LITERS IA
Irrigation
240 mg gent.
and 600 mg
clinda.
300 cc
Wound
Irrigation
1 LITER
Wound
Irrigation
LAP
Wound Class
2 Clean
Contaminated
3 Contaminated
Wound Class
4 Dirty
n/a Wound Class
all
n/a
OPEN
Wound Class
2 Clean-
Contaminated
n/a Wound Class
3 & 4
Contaminated-
Dirty
n/a Wound Class
all
The result of our bundled, consistently applied protocol for colon
resections? A decrease in our SSI rate, a rate that had already been
quite good on the national level, and words of praise from infectious
disease. — Kristin M. Noonan, MD, FACS, FASMBS
Dr. Noonan (kristin.noonan@jefferson.edu) is the director of quality and safety as
well as the associate director of the surgical residency program for Abington –
Jefferson Health, which has 2 hospitals and a number of outpatient centers in sub-
urban Philadelphia.
